Fentanyl-related cardiac arrest linked to worse neurological injury, outcomes

SEATTLE — Fentanyl-related cardiac arrest is associated with worse neurological injury and outcomes compared with cardiac arrest from other opioids, according to a presenter at the 2022 American Academy of Neurology annual meeting.

“Opioid-related cardiac arrest has become the No. 1 cause of death in the U.S. in [those] aged 18 to 64 [years],” Matheus Otero, a research scholar at the University of California, San Francisco, said during his presentation. “There’s a lot of talk about the opioid crisis, but it’s actually becoming the fentanyl crisis.”

Seeking to determine whether fentanyl-related cardiac arrest could be linked to worse neurological injury and outcomes compared with cardiac arrest from other opioids, Otero and colleagues reviewed the medical records of 238 patients, all of whom had sustained return of spontaneous circulation after out-of-hospital cardiac arrest and were admitted to Zuckerberg San Francisco General Hospital from 2019-2021.

Upon admission, patients underwent toxicology urine tests for the presence of fentanyl, methamphetamine, cocaine or benzodiazepines and were evaluated for brain injury via EEG.

Of 56 patients who tested positive for fentanyl or other opioids, 36 cardiac arrests were directly related to fentanyl overdose. Researchers found that fentanyl patients had 54.8% EEG burst suppression, compared with none in other opioids patients and 39.8% in all other patients.

Further, fentanyl patients had 77.4% malignant EEG compared with 33.3% in other opioids and 64.7% in all others.

“That shows a clear difference in pathophysiology of injury between fentanyl and different types of opioids,” Otero said. “That could lead to better neuroprognostication to tell us if these patients have a better chance for recovery.”